Therapist Questionnaire

Here’s an example of a form one of our members used in his quest to find decent service providers. Feel free to copy this and send it to potential doctors or use the questions as a guide when interviewing your doctors. Remember, it’s your journey. You get to choose who accompanies you on it!

THERAPIST QUESTIONNAIRE

YOUR NAME: ____________________________

DATE: _____________

Please answer ALL questions. If you already have a pre-existing document that addresses some or all of the questions below, you can substitute that document in lieu of fully completing this form provided that (1) you indicate which questions are addressed by the document and (2) the combination of this questionnaire and the document completely address ALL of the questions listed. Please attach additional pages as necessary.

How long have you been a practicing therapist?

Do you have a degree or license to practice therapy?

What do you consider to be your area of expertise?

What is your hourly rate? How long are your session times?

Do you offer a “sliding fee scale?” If so, under what circumstances?

Are you a member of any Preferred Provider Network? If so, which?

Are you practices consistent with the WPATH Standards of Care (SOC) version 7?

Do you understand how they changed in 2011?

Have you ever counseled any transgender clients?

If so, how many? How many were assigned female at birth or assigned male at birth?

On average, how long were your transgender clients in a therapist-clients therapeutic relationship with you?

Have you ever diagnosed anyone with Gender Dysphoria? If yes, how many times?

Do you write referral letters to medical doctors who provide HRT?

Do you write referral letters to medical doctors who provide transition-related surgeries?

Do you treat transgender youth or children?

Do you consider yourself a qualified “clinical behavioral scientist” as that term is defined under the WPATH Standards of Care (SOC) version 7? If so, please state why you feel you are qualified.

What is your professional opinion of people who feel they are transgender? What is your personal opinion?

Please list any comments you may have here:

Thank you for completing this questionnaire. Please return it using the enclosed envelope to:

Name

Address